Provider Demographics
NPI:1548771496
Name:AUTHENTIC LIFE TRANSITIONS, LLC
Entity Type:Organization
Organization Name:AUTHENTIC LIFE TRANSITIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MAHAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:940-453-0872
Mailing Address - Street 1:3001 ALOMA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3752
Mailing Address - Country:US
Mailing Address - Phone:321-420-6095
Mailing Address - Fax:407-530-1935
Practice Address - Street 1:3001 ALOMA AVE STE 204
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3752
Practice Address - Country:US
Practice Address - Phone:321-420-6095
Practice Address - Fax:407-530-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9160103T00000X, 103TB0200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty